=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427127109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY K EXLINE PAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12200 WEBER HILL RD STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63127-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-842-5660
-----------------------------------------------------
Fax | 314-842-0169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12200 WEBER HILL RD STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63127-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-842-5660
-----------------------------------------------------
Fax | 314-842-0169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 2010004021
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------